This is how privatisation is ruining NHS England – we need to stop it happening in Scotland

This is how privatisation is ruining NHS England – we need to stop it happening in Scotland

SHORTLY before his death, Stephen Hawking warned that the government is taking the NHS “towards a US-style insurance system, run by... private companies”, and he argued: “We must prevent the establishment of a two-tier service.” That moral case is clear.

In addition, the huge cost of the American model – double our own – is down to the wasteful competition of commercial interests, with involvement of an army of accountants, lawyers and marketing men.

The World Health Organisation defined privitisation in healthcare in 1995. Privatisation means a process in which non-government actors become increasingly involved in the financing and provision of healthcare and/or a process in which market forces are introduced into the public sector.

The long gradual road to privatisation really started with Thatcher in the 1980s and made some progress with Blair’s Labour government. During the eight years up to 2015, the proportion of the English NHS budget that went to private companies increased from 2.8% to 7% and is still rising.

Things changed radically with the passing of the Health and Social Care Act of 2012. Within two years, further regulations required commissioning of services in both primary care and in hospitals. This meant that NHS authorities were obliged to put every contract out to competitive tender, which opened up the field to healthcare providers such as Capita, Virgin, Atos, G4S and Serco.

When this Bill passed through Westminster, well over 200 members actually had shares, directorships or consultancies in companies which were health care providers. This did not exclude them from voting for the passage of the Bill.

The result was the award of contracts (even to run an entire hospital) to companies whose main priority was to make money for their shareholders. This sometimes involves running an entire hospital which is clearly different from outsourcing of a particular service (e.g. cleaning or sterile supplies).

In the famous example of Hinchingbrooke Hospital, Circle Health found they were making large losses and, despite attempted corruption (offering a fee to GPs who referred patients) finally handed it back to NHS control after less than five years. Millions in accumulated losses were borne by the taxpayer.

The English system involves commissioning groups in both primary and secondary care, with the requirement that both commercial companies and NHS groups can tender.

There have been legal challenges from companies such as Virgin Care who sued the NHS last year over the award of an £82 million contract to provide children’s health care in Surrey. Richard Branson was awarded £2m compensation from the taxpayer because there were “flaws in the way the contract was awarded”!

Another reaction to the need to save money is that some treatments have been rationed. One survey of trusts found that 66% limited cataract surgery (some only doing one eye), 59% bariatric surgery for obesity (some only doing it for obese people with BMI over 50 whereas NICE recommends a BMI of 40 or over) and 59% joint surgery (hip/knee replacement).

Some hospitals are offering patients the chance to “self-fund” treatments that are deemed “non-essential” at NHS prices – effectively the start of a two-tier service within the NHS. These include in vitro fertilisation (IVF), bone scans, cancer surgery and screening for hereditary diseases.

A few years ago we worried greatly that the UK would be dragged into TTIP – a trade treaty with the US which would probably have opened up the NHS market to aggressive American healthcare companies. Fortunately the EU decided not to sign up to TTIP.

However, much the same threat has reappeared. With Brexit looming and the Tories desperate to find markets outside the EU, the big danger is that predatory American companies will finally get access to our healthcare system. If this happens and Scotland has not gained independence, it will be difficult to prevent the same companies penetrating and distorting our Scottish NHS.

Dr Willie Wilson is a retired academic pharmacologist and Convener of NHSforYES

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